Covered Entity Details

The Covered Entity Details section displays information from the parent hospital and allows you to record any additional information for the outpatient facility.

Covered Entity Details
Item	Description
Sub-Division Name	Type the exact sub-division name of the outpatient facility only. The sub-division name should closely reflect the services being provided on the cost center line being registered.
Specific Clinic or Service	Type the name of the specific clinic or service being registered (e.g., Dermatology, Podiatry).
Outpatient EIN	Type a new EIN if the IRS has assigned one that is different from the parent hospital (otherwise, leave blank).
Outpatient Facility Provider Number	Type a new provider number if different from Medicare Provider Number of the parent hospital. Otherwise, leave blank.
Cancel	Cancel the registration and return to the home page.
Next	Click this button to proceed.